A Head-to-Head Comparison Between [F]Fluorodeoxyglucose ([F]FDG) Positron Emission Tomography/Computed Tomography (PET/CT) and Technetium-Hexamethylpropylene Amine Oxime (HMPAO)-Labeled Leukocyte Scintigraphy in a Case Series of Patients with Suspected Vascular Prosthesis Infection: To Trust Is Good, but to Check Is Better.

Prosthetic vascular graft infection (PVGI) is a serious complication associated with vascular prostheses. Nuclear medicine techniques, including [F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and technetium-hexamethylpropylene amine oxime (HMPAO)-labeled leukocyte (WBC) scintigraphy, are part of the MAGIC diagnostic criteria for PVGI. In this retrospective study, we analyzed eight patients with suspected PVGI who underwent both [F]FDG PET/CT and WBC scintigraphy within an average of 8 days. Of all eight patients (median age 69 years), three showed concordant positive results with both PET/CT and WBC, and their final diagnosis confirmed the presence of infection; five showed discordant results: in all five of these patients, PET/CT showed false-positive findings, whereas WBC correctly identified five true-negative cases. [F]FDG PET/CT is highly sensitive but prone to false positives. WBC scintigraphy, combined with SPECT/CT, particularly in the evaluation of the treatment response, showed greater specificity, and it may warrant consideration as a MAGIC major diagnostic criterion for PVGI.